The "Wings" Depressive Symptom Intervention for Latina Mothers

描述（由申请人提供）：英语能力有限（LEP）的婴儿和幼儿的拉丁母亲面临着长期的经济困难和移民相关的压力。高达64%的人经历了临床上显著的抑郁症状，这限制了他们为婴儿或幼儿提供发育支持的能力。婴儿/幼儿暴露于母亲抑郁症状与语言缺陷和持续发育滞后有关，在年龄较大的儿童中，行为障碍和社会攻击性。在美国，许多拉丁美洲人的“新目的地”地区没有足够的双语心理健康服务，LEP拉丁裔母亲无法获得治疗。“翅膀”干预，以减少抑郁症状有显着的影响，在80拉丁LEP母亲在早期的头部启动（EHS）。为了准备更大规模的干预试验，本研究将最终完善干预措施，并测试选定方法和方案的可行性、可接受性和安全性。干预是一个10届会议，在家庭修改人际心理治疗（IPT）提供的英语高级实践精神科护士与双语，项目培训的社区口译员配对。它旨在帮助母亲减少抑郁症状，科普压力，增加社会支持和更有效地养育子女。将最终确定的干预措施包括解决人际冲突和促进家庭团结的战略，支持拉丁美洲尊重价值观的额外育儿指导和教育[负责任的行动]，增加了干预后维护会话（PIM）延长症状的减轻时间，并强调帮助母亲与现有社区机构联系，以获得同伴和团体的社会支持。本研究还将测试病例管理/控制条件和入组前心理健康评估的方案;确定招募、筛选和入组方案的可行性以及既往研究中未使用的工具的管理。最后，该研究将评估20名拉丁裔母亲的可行性，可接受性和安全性，这些母亲在流行病学研究中心抑郁量表（CES-D）上得分为16分或更高，并且从社区机构招募了6周到36个月大的婴儿或幼儿。受试者将被随机分配到干预或病例管理/对照条件，并在三个收集点（基线、12周和6个月）进行测量。将使用西班牙语版本的汉密尔顿抑郁症评分销售（HRSD）沿着其他测量（PSI; CBCL;年龄和阶段量表-社会情感; HSI-I，ARSMA-II，社会支持和自我效能）。这项研究将支持一个更大的随机试验，并最终将“翅膀”干预纳入社区诊所，早期干预计划和拉丁美洲服务机构。 公共卫生相关性：婴儿和幼儿的发育可能会因母亲暴露于抑郁症状而受到损害。该项目将确定帮助讲西班牙语的拉丁裔母亲减少抑郁症状的短期家庭干预是否可行和安全，以及是否可以进行更大规模的测试所需的方法。最终，通过改善这些母亲的心理健康，他们的婴儿和幼儿的发展和适应社会将得到加强。

DESCRIPTION (provided by applicant): Limited English Proficiency (LEP) Latina mothers of infants and toddlers are confronted with chronic economic hardship and immigration-related stressors. As high as 64% experience clinically significant depressive symptoms, which limit their ability to offer developmental support to their infant or toddler. Infant/toddler exposure to maternal depressive symptoms has been linked to language deficits and persistent developmental lags, and in older children, conduct disorders and social aggression. Many "new destination" areas for Latinos in the US have inadequate bilingual mental health services and LEP Latina mothers cannot get treatment. The "Wings" intervention to reduce depressive symptoms had a significant impact in 80 Latina LEP mothers in Early Head Start (EHS). To prepare for a larger trial of the intervention, this study will finalize refinements to the intervention and test the feasibility, acceptability and safety of selected methods and protocols. The intervention is a 10-session, in-home modification of Interpersonal Psychotherapy (IPT) delivered by English-speaking advanced practice psychiatric nurses paired with bilingual, project-trained community interpreters. It is designed to help mothers reduce depressive symptoms, cope with stress, increase social support and parent more effectively. Refinements to the intervention that will be finalized include strategies to resolve interpersonal conflict and promote familismo [family unity], additional parenting guidance that supports Latino values of respeto [respectfulness] and educacisn [responsible actions], the addition of post- intervention maintenance sessions (PIMs) to prolong the reduction of symptoms and emphasis on helping mothers connect to existing community agencies to access peer and group social support. This study will also test protocols for a case management/control condition and a pre-enrollment mental health assessment; determine the feasibility of recruitment, screening and enrollment protocols and the administration of instruments not used in previous studies. Finally, the study will evaluate feasibility, acceptability and safety of the revised methods in 20 Latina mothers who score 16 or greater on the Center for Epidemiological Studies Depression Scale (CES-D) and who have infants or toddlers between 6 weeks and 36 months old recruited from community agencies. Participants will be randomized to the intervention or to a case management/control condition and measured over three collection points (baseline, 12 weeks and 6 months). Spanish versions of the Hamilton Rating Sale for Depression (HRSD) will be used along with other measures (PSI; CBCL; Ages and Stages Questionnaires - Social-Emotional; HSI-I, ARSMA-II, social support and self-efficacy). This study will support a larger randomized trial, and ultimately the integration of the "Wings" intervention into community clinics, early intervention programs and Latino-serving agencies. PUBLIC HEALTH RELEVANCE: The development of infants and toddlers may be harmed by exposure to depressive symptoms in their mother. This project will determine whether a short-term, in-home, intervention to help Spanish-speaking Latina mothers reduce their depressive symptoms is feasible and safe and whether the methods needed to test it on a larger scale can be carried out. Ultimately, by improving the mental health of these mothers, their infants and toddlers' development and adaptation to society will be enhanced.